shoulder instability and dislocation (keyhole)

What is Shoulder Arthroscopy (Keyhole)?

As one of the most overworked parts of our body, our shoulders can take a real beating – especially in highly active individuals. What we call the simply call the shoulder is actually made up of joints, tendons, and muscles that allows it to have a wide range of motion. However, mobility has its price that may lead to problems like shoulder weakness or instability, impinged soft tissues, or dislocation. People seek help for shoulder pain because it can greatly hinder one’s ability to move freely without any discomfort.

So, where do we draw the line from common shoulder pain from what could be a potentially serious shoulder injury? Prudence would dictate that if any sensation is making it painful or harder for you to move your shoulders, the best course of action is to consult a doctor.

The surgery is recommended to patients with a painful condition that is unresponsive to non-surgical treatment. Non-surgical interventions include rest, physical therapy, and medications to reduce inflammation.Even though shoulder arthroscopy is an outpatient procedure, it is still a surgical procedure which comes with the usual risks and potential complications. You will only be considered for surgery after conservative, non-surgical options have been tried first.

An unstable shoulder, which frequently dislocates or partially slips out of joint, can cause pain and limit your range of motion. This may give you the feeling that moving the shoulder a certain way might cause it to fully dislocate or subluxate (partially dislocate). Once the tendons, ligaments, and muscles around the shoulder become loose or torn, dislocations can repeatedly occur.This procedure is suitable for patients who experience repeated episodes of subluxations or dislocations which can lead to an increased risk of arthritis in the joints.

Your doctor may suggest a shoulder arthroscopy if you have damage from an injury, arthritis, or other health conditions. If you find that the shoulder pain you have is becoming unbearable by the day, and is already disrupting your normal daily activities, then you may be a potential candidate for a shoulder arthroscopy.

Stabilisation surgery will involve general anaesthesia, which means that you will be asleep throughout the procedure. It usually takes about 30 minutes to an hour depending on what the surgeon needs to do inside your shoulder joint. You may have it sitting on a deckchair position or in a side-lying position.

Once the anaesthetic has taken effect, your surgeon will make 2-3 small incisions around the shoulder through which the arthroscope (a tube-like telescope) will be inserted. This instrument has the same thickness as that of a drinking straw and has a camera on its tip.

Your surgeon will examine your shoulder and assess the damage inside your joints, bones, and soft tissues by looking at the images from the arthroscope on a monitor. If they find any damage, they will use specialised surgical instruments to repair it. Muscles, ligaments and tendons may be stitched together, and any damaged tissue that impairs the shoulder’s full range of motion will be removed.

At the end the surgeon will close the incisions with an external stitch and then covered with a waterproof dressing.

The fact that it is an invasive procedure already opens you to the risk for infection and bleeding. Stiffness is also a common risk which you may experience for a certain amount of time. This is usually caused by scar tissue that forms in the area. It can be eased with physical therapy.

You may also experience some weakness on the affected arm after the procedure. This can also be rectified through physical therapy. A major, but rare, risk of shoulder arthroscopy is nerve damage. This can cause issues with your arm and hands. This is only temporary, but it may also result in permanent complications. The risk of recurrent dislocation or instability after surgery

Once the decision to proceed to surgery has been made, make arrangements to take a leave from work to give you time to recuperate. You will be advised to get a clearance from your primary care physician or specialist. A pre-operative lab work-up will also be requested as some tests are required before you can be under anesthesia.

Medications like Coumadin/Warfarin, Aspirin, Plavix and NSAIDs or your arthritis medications can prolong bleeding time. You will be advised when to stop taking it in preparation for surgery to prevent excessive bleeding.

If you smoke, you may have to stop at least 4 weeks prior to the procedure because it can increase your risk of getting chest or wound infection which can slow down your recovery. It can lead to complications and it will make your surgery less effective.

Don’t drink or eat anything after midnight the night prior to surgery. You need to have an empty stomach to be ensure that you will be safe under anaesthesia. Additionally, alcoholic beverages must be avoided 48 hours before surgery because it delays stomach emptying and impairs proper wound healing.

Take a good shower and pay close attention in cleaning the area that will be operated on. Remove any nail polish because the surgical team will assess your nailbeds during the surgery to monitor if the affected arm is still receiving adequate blood circulation.

You may be able to go home the same day, but if you underwent general anaesthesia you will be taken from the operating room to a recovery room for close monitoring. After this, you will be taken to your room or a comfortable area where you can rest until you are ready to go home

It may take several hours before any sensation comes back into your shoulder. For that reason, take extra care not to bump or knock your shoulder. Expect some discomfort in the area once the effects of anaesthesia has worn off, but this can be relieved by prescribed analgesics. You may also find that you will have some difficulty with your coordination, so you should have made arrangements with someone to drive you home or accompany you there for the first 24 hours.

It is important that you also made the proper arrangements from work because it is essential that you rest your arm. Most people can return to work earlier, but it may take longer if your job involves some lifting or carrying. You must follow your surgeon’s advice about going back to your usual physical activities, exercise, or sports. Your surgeon will give you a detailed and customized instruction based on your lifestyle and the outcome of your arthroscopy.

Swelling is expected for the first 24 hours due to the collection of sterile fluid used during the operation to allow better visualization inside the joint. A cold compress, such as an ice pack or a bag of frozen peas wrapped in a clean cloth can help minimize the pain, swelling, and bruising.

The soiled, bulky dressing applied on the closed incisions will be replaced with a waterproof dressing which has to be left in place until the post-op check-up. Observe the dressing if you notice that it is already soaked or is giving off a foul odor. You have to report this right away because it could be a developing infection. You may shower but make an effort not to directly soak the dressing.

You will be fitted with an arm sling and you will be given instructions on how to manage it. You should wear it during the day where you can take it off for brief periods, and remove it when you go to sleep.

Pain is your body’s way of telling you that something is not right. Don’t just brush it off and risk the chance of comprosing your movement and interupting your daily activities. Get it checked today for the right intervention the soonest possible time. Book your appointment with Dr. Dutton, here.